…is a diagnostic pathway. The unstable patient Hypotension (systolic < 90 mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac…

…compressible vessel. Allen's test is still used in many units to assess the collateral circulation, but the test does not reliably predict ischaemic complications…

…infection and organ dysfunction must therefore be managed as neutropenic sepsis even if the temperature criterion is not met. The first hour Step Action : : 1…

…empirical intravenous antibiotics, fluid, a vasopressor and early source control. Sepsis is a dynamic condition. Investigation and treatment must therefore proceed in parallel and must…

…calibrated. Working venous access, fluid and a vasopressor drawn up — push dose noradrenaline or phenylephrine must be ready before induction , not looked for afterwards. Monitoring…

…the patient down. Injection Needle Angle Maximum volume per site : : : : Deltoid, adult 23–25 G, 25 mm 90° 1–2 mL Deltoid, BMI 35 or…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…respond to maximal ACTH stimulation, and it is rarely the injection itself that determines whether the result can be interpreted. What decides that is whether…

…IV Dose Bolus injection : 5 to 15 mg every 5 to 15 minutes as necessary. Continuous infusion: Start infusion at 0.1 mg/min and…

…and Clinical Role Invasive coronary angiography (ICA) is a catheter based investigation that visualizes the coronary arterial tree after selective intracoronary contrast injection under fluoroscopy…

…infection or gastroenteritis at home Double or triple the oral daily dose during the days of illness (the patient's sick day rules) Vomiting or…

…Sterile gloves, sterile gauze, and a fenestrated drape for injection. A needle of 0.8–1.2 × 50 mm for large joints (knee, shoulder), 0…

…transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal saline and give by slow injection over 5…

…Injection of contrast media into the ventricle will instead reveal that the apical portion of the left ventricle is dilated (hence the term apical ballooning…

…be secured. Preparation and equipment Edrophonium 10 mg/mL, 1 mL (named patient product — order well in advance). Atropine 0.5 mg for premedication, plus…

…one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side, with the needle tip directed volarly until…

…find the right level is to give a small dose, wait until it has worked, and assess the effect before the next one is given…

…for neurological, respiratory or haemodynamic failure that cannot be corrected quickly. Rapid sequence induction is used when intubation is required [1]. In salicylate poisoning, intubation…

…of these highly efficient elimination pathways, adenosine has an extremely short elimination half life of 1 to 6 seconds. Most of the drug's pharmacological…

…strut coverage. OCT has limited tissue penetration, generally approximately 1–3 mm, and may not show the EEM through substantial plaque or calcium. Blood clearance…

…Central venous administration of adenosine is suitable in the intensive care unit or coronary care unit. Adenosine injection must be administered quickly (1 2 seconds)…

…treatments that can be attempted until a pacemaker is established. Drug Effect Dose, kinetics Comment Atropine Acetylcholine receptor antagonist 1 mg IV every 3 5…

…high risk of infection. Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18% show significant valvular disease. Table 1…

…will heal badly however neatly the suture is placed. The commonest cause of wound infection is retained contamination, not poor suture technique — and the commonest…

…early: 1. Assess airway, work of breathing, level of consciousness and circulation. 2. Give controlled oxygen with a target of 88 to 92 percent until…

…cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with previous complicated withdrawal [4]. Untreated delirium…

…low platelet counts, followed by compression. Infection in the skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow…

…cannula bridges the gap until conditions are controlled. Contraindications In life threatening conditions all contraindications are relative — but they govern which site is chosen. Infection…

…the eGFR stages and albuminuria. Inflammation and infection Test Reference Comment : : : CRP < 3 mg/L Rises within 6–8 h, half life about 19…

…Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a self taken vaginal sample without a speculum…

…Suspected subarachnoid haemorrhage with a normal or non diagnostic CT. Suspected neuroborreliosis, neurosyphilis or another CNS infection. Suspected inflammatory disease: multiple sclerosis, Guillain–Barré syndrome…

…spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy: an otoscope with a charged battery and clean disposable specula…

Procedurer In acute circulatory failure it is not the number of cannulae that matters but the flow per unit time . A large bore, short cannula…

…between regions. Common practice is correction at an INR above 1.5 and a platelet count below 50 × 10⁹/L before drain insertion, while diagnostic…

…the top (< 1 second). 5. A maximal forced expiration : an explosive start and then continued blowing with loud coaching until a plateau is reached…

…Dose Injections • IV: 10–40 mg every 4–6 hours • IM: 10–20 mg every 4–6 hours. Infusion • Afterload reduction : Start infusion at 1…

…minutes Duration of action 2 to 4 hours Delivery IV Dose Can be given as repeated intravenous bolus injections or as a constant dose infusion…

…in increased levels of circulating pro inflammatory cytokines that may cause plaque rupture (i.e the risk of atherosclerotic plaque rupture is increased during infections)…

…causally responsible. This distinction is important because AKI after a contrast study frequently occurs in patients with several simultaneous renal insults. Infection, hypovolaemia, cardiac dysfunction…

…inclisiran permits subcutaneous administration only twice yearly, an important practical distinction from therapies requiring monthly or biweekly injections. Inclisiran is used as an adjunct to…

…abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate the procedure while awake. Suspected…

…Temperature Treat fever and look for an underlying infection Swallowing Keep the patient nil by mouth until swallowing has been assessed The plasma glucose is…

…and are given for absolute eGFR in mL/min , not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller…

…individual assessment; certain tumour types are not a bar). Untreated generalised infection, or certain transmissible agents according to the current transmission risk assessment. In DCD…

…kg) 10 days or benzylpenicillin 1–3 g × 3 IV Extensive furunculosis flucloxacillin 1 g × 3 10 days Wound infection flucloxacillin 1 g × 3 7…

…10–21 mmHg). Tonometry is contraindicated with suspected perforation or infection. Removal Proceed from the least to the most invasive technique. 1. Irrigate with sterile…

…few days. Principles Insulin component Function Who needs it : : : Basal insulin (intermediate or long acting) Covers fasting glucose production Everyone with type 1 diabetes, always…

…both legs acutely increases preload. Untreated deep vein thrombosis in the acute phase. Septic phlebitis, ongoing soft tissue infection with systemic involvement. Relative: Condition Adaptation…

…Diagnostic question Method Comment : : : Pigmented lesion, suspected melanoma Excision with a 1–3 mm margin, down into the subcutis Never a shave — the depth must…

…benzodiazepine (midazolam or diazepam) is the commonest combination; propofol is used in units with airway expertise. Procedure 1. Dry the skin and shave where necessary…

…PAWP ≤15 mmHg, and PVR ≤2 Wood units may have increased pulmonary blood flow rather than pulmonary vascular disease. This state is termed unclassified PH…

…schizoaffective disorder, HIV infection or other circumstances that may affect cessation or treatment monitoring. Single question screening can identify unhealthy drug use requiring counselling regarding…

…muscle disease or a personal or family history of muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency Concomitant interacting medications The…

…larynx. Procedure 1. Inspect both nasal passages and choose the more patent one. Ask the patient about a previous nasal fracture or unilateral nasal obstruction…

…recent oesophageal or gastric surgery Gastric lavage Seizures or an unstable patient — stabilise first The induction of vomiting has no place in the modern treatment…

…straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin…

…varies widely and may involve intrinsic cardiac disease, extrinsic systemic conditions, or pharmacologic effects. Inflammatory heart disease, caused by infections (viral, bacterial, protozoal, fungal, parasitic)…

…most often enzyme induction by alcohol or drugs and is often of no clinical significance. Synthetic function and prognosis Child–Pugh Parameter 1 point 2…

…antibody directed against interleukin 1β, provided proof of concept but was not developed for routine coronary prevention because of fatal infections and high cost…

…income countries, presumably because streptococcal infections are treated very liberally. Figure 1 shows the aortic valve in PSAX (parasternal short axis view). Figure 1. The…